Self-management plan of chronic disease among inpatients admitted to a Portuguese Endocrinology unit: a best practice implementation project.

INTRODUCTION: Globally, there is an increasing incidence of chronic diseases, particularly, diabetes. Patient engagement in disease self-management is essential to improve outcomes and reduce consumption of health resources. Despite investment in this area, there is a need to improve nursing care practices. AIMS: To increase compliance of Endocrinology nurses with best practice in promoting self-management of diabetes by patients. METHODS: The project was conducted in an Endocrinology unit of a Portuguese central hospital. It was based on the JBI's model approach, considering three phases: baseline audit, strategy design and implementation, and follow-up audit. For the audits, 11 criteria were considered. The sample was composed of patients (15 in the baseline; 30 at the follow-up audit), and nurses (15 in both audits). RESULTS: The baseline audit showed that there was poor compliance in some criteria. Four barriers were identified and the strategies/resources to mitigate them. There was improvement in all audit criteria as the project developed (100% compliance in seven criteria; two criteria increased from 0 to 100%). CONCLUSION: The evidence-based implementation project improved nursing practices for self-management planning of the person with diabetes. The adequacy of the strategies developed should be highlighted, namely the training and reflection on practices. The creation of the standardized discharge procedure has also improved compliance (criteria 7-10). The culture of patient-centred care, the desire to provide quality care, the involvement of the nurse manager, informal leaders, and the support office for information and documentation systems in nursing were facilitators in this process.

Fluidez sexual: contextualização histórica e contributos teóricos / Fluidez sexual: contextualización histórico y aportaciones teóricas / Sexual fluidity: historical contextualization and theoretical contributions

RESUMO. Neste estudo, tivemos como objetivo aprofundar o conceito de fluidez sexual pela análise crítica da literatura e de uma síntese integrativa sobre o tema. Nele, analisamos estudos que se debruçam sobre a fluidez sexual, exploramos o conceito, sob orientação do modo como Lisa Diamond o introduz na literatura científica, o define e operacionaliza. Por fim, debruçamo-nos sobre estudos no âmbito da fluidez sexual, a fim de perceber os significados atribuídos, e questionando o potencial viés de gênero que acompanha um conceito situado num tempo e num contexto heteronormativos. Como contributo para o aprofundamento do conceito e reforço das suas potencialidades, são apresentadas reflexões sobre a relação entre a fluidez sexual e a masculinidade hegemônica, uma relação pouco valorizada na literatura científica. Globalmente, este trabalho promove, criticamente e de modo interseccional, o questionamento sobre a fixação no sexo/gênero das pessoas envolvidas numa situação sexual e são discutidas as fronteiras do conceito de fluidez sexual e a sua (im)permeabilidade.

RESUMEN. En este estudio, buscamos profundizar el concepto de fluidez sexual a través de un análisis crítico de la literatura y de una síntesis integradora sobre el tema. Para tal, se analizaron estudios enfocados en la fluidez sexual y se exploró este mismo concepto según la guía de cómo Lisa Diamond lo introduce en la literatura científica, lo define y lo concretiza. El análisis de los estudios en torno de la fluidez sexual se realizó teniendo como objetivos comprender los significados atribuidos al concepto y cuestionar el posible sesgo de género que acompaña un concepto ubicado en un tiempo y en un contexto heteronormativos. De cara a profundizar el concepto y reforzar su potencial, se presentan reflexiones sobre la relación entre la fluidez sexual y la masculinidad hegemónica, una relación que no se tiene en cuenta habitualmente en la literatura científica. En general, este trabajo contribuye, de manera crítica e interseccional, al cuestionamiento sobre la fijación en el sexo/género de las personas involucradas en una situación sexual y discute los límites del concepto de fluidez sexual y su (im)permeabilidad.

ABSTRACT. In this study, we sought to deepen the concept of sexual fluidity through a critical analysis of the literature and an integrative synthesis on the topic. In it, we analyzed studies that focus on sexual fluidity, explored the concept, under the guidance of how Lisa Diamond introduces it into the scientific literature, defines it, and operationalizes it. Finally, we focused on studies on sexual fluidity, trying to understand the meanings attributed to the concept, questioning the potential gender bias that accompanies a concept located in a heteronormative time and context. As a contribution to the deepening of the concept and reinforcement of its potential, reflections are presented on the relationship between sexual fluidity and hegemonic masculinity, a relationship that is little valued in the scientific literature. Overall, this work promotes, critically and in an intersectional way, the questioning about the fixation in sex/gender of people involved in a sexual situation and discussed the boundaries of the concept of sexual fluidity and its (im)permeability.

Conhecimento dos profissionais de saúde sobre cuidados paliativos: Análise de um hospital central português / Health professionals' knowledge of palliative care: Analysis of a Portuguese central hospital / Conocimiento de los profesionales de la salud sobre cuidados paliativos: Análisis de un hospital central portugués

Resumo Enquadramento: A evidência científica revela lacunas de conhecimento dos profissionais de saúde em cuidados paliativos, influenciando a qualidade dos cuidados. Objetivo: Caracterizar o conhecimento em cuidados paliativos dos profissionais de saúde, num hospital central universitário português. Metodologia: Estudo quantitativo, descritivo-correlacional, transversal, tendo como população-alvo os profissionais de saúde de um hospital central universitário. Aplicou-se um questionário para avaliar os conhecimentos sobre cuidados paliativos. Resultados: Dos 401 profissionais da amostra, 16,96% detém experiência e 26,18% formação específica em cuidados paliativos. Em média, identificou-se 80,53% de respostas corretas sobre filosofia dos cuidados paliativos. O conhecimento sobre controlo de sintomas e apoio à família relacionam-se negativamente com o tempo de exercício profissional (p < 0,001). Conclusão: A maioria dos profissionais demonstra conhecimento em cuidados paliativos, todavia é essencial investir na formação, particularmente nos profissionais com maior tempo de exercício profissional.

Abstract Background: Scientific evidence shows gaps in the knowledge of health professionals about palliative care, influencing the quality of care. Objective: To characterise health professionals' knowledge about palliative care in a Portuguese central university hospital. Methodology: Quantitative, descriptive-correlational, cross-sectional study, with health professionals from a central university hospital as target population. A questionnaire was applied to assess their knowledge about palliative care. Results: Of the 401 professionals in the sample, 16.96% have experience and 26.18% specific training in palliative care. On average, 80.53% of correct answers were given regarding the philosophy of palliative care. The knowledge about symptom control and family support was negatively correlated with the length of professional experience (p < 0.001). Conclusion: Most professionals demonstrate knowledge in palliative care, however it's essential to invest in training, particularly in professionals with more length of professional practice.

Resumen Marco contextual: La evidencia científica revela lagunas en los conocimientos de los profesionales de la salud en materia de cuidados paliativos, lo que influye en la calidad de la atención. Objetivo: Caracterizar los conocimientos sobre cuidados paliativos de los profesionales de la salud en un hospital central universitario portugués. Metodología: Estudio cuantitativo, descriptivo-correlacional, transversal, con profesionales de la salud de un hospital central universitario como población objetivo. Se aplicó un cuestionario para evaluar los conocimientos sobre cuidados paliativos. Resultados: De los 401 profesionales de la muestra, el 16,96% tenía experiencia y el 26,18% formación específica en cuidados paliativos. Por término medio, se identificó un 80,53% de respuestas correctas sobre la filosofía de los cuidados paliativos. Los conocimientos sobre el control de los síntomas y el apoyo familiar están relacionados negativamente con la duración del ejercicio profesional (p < 0,001). Conclusión: La mayoría de los profesionales demuestran tener conocimientos en cuidados paliativos, sin embargo, es fundamental invertir en formación, sobre todo para los profesionales con mayor tiempo de ejercicio profesional.

Older people's views and expectations about the competences of health and social care professionals: a European qualitative study.

Adapting and providing quality services for people as they age is a common challenge across Europe. The perspective of older people is fundamental in a person-centred care approach. Expanding research at the European level that explicitly includes their views can offer a relevant contribution to the development of evidence-based guidelines that can be shared in education and training across health and social care professions. This study aimed to identify common meaningful dimensions of professional competence in health and social care emphasised by older people from six countries in different regions of Europe according to their experiences. A qualitative approach was chosen with a total of 95 semi-structured interviews conducted in Austria, Finland, Lithuania, Portugal, Turkey and UK, following a common topic guide. Participants in this study were aged 60 and above, and recruitment considered age, gender, level of education and living arrangements. Results identified a set of universal skills and practices that according to older people, health and social care professionals should meet. Competences at the interpersonal level were central in older people's discourses, and its core dimensions are anchored in relational, communication and socio-emotional skills of professionals. These findings reinforce the aspiration of establishing best practices in care that relies on the harmonisation of a competence framework that can be shared in the training and education of health and social care professionals across Europe and that voices older people's preferences, expectations and needs.

The Exchange Relationship between Work-Family Enrichment and Affective Commitment: the Moderating Role of Gender.

Workers' perception that their job experience enriches their family life has been considered a mechanism that explains their positive attitudes toward the organization where they work. However, because women and men live their work and family differently, gender may condition this relationship between the work-family enrichment and workers' attitudes. With a sample of 1885 workers from one Portuguese bank, with 802 women, the current study investigated the relationship between work-family enrichment and organizational affective commitment as well as the role of sex as a moderator of this relationship. The hypotheses were tested by using regression analysis. The results indicated that the perception held by workers that their work enriches their family is positively correlated with their affective commitment toward the organization. Furthermore, the data revealed that this relationship is stronger for women than for men. Study results have implications for management, particularly for human resource management, enhancing their knowledge about the relationship of work-family enrichment and workers' affective commitment toward organization.

Lesbians on Medical Encounters: Tales of Heteronormativity, Deception, and Expectations.

The experiences of lesbian women in medical encounters prove particularly relevant for understanding their difficulties in their relationship with professionals and health services. We carried out semistructured interviews with 30 women aged 21 to 63 years, who define themselves as lesbian. The analysis highlights the difficulties experienced in disclosure of sexuality in medical encounters, the tendency for doctors to come across as heteronormative, and also medical practices experienced as appropriate by interviewees. Analysis of participant experiences demonstrates the need for reflection and decision making to promote the recognition of the sexual citizenship of lesbian women and their empowerment.

[The lesbian population in health studies: contributions for a critical reflection]. / A população lésbica em estudos da saúde: contributos para uma reflexão crítica.

For decades, lesbian sexuality was associated with pathology in the attitudes to and practices of health sciences and psychology. During the twentieth century that position changed gradually. This article analyzes these changes in a theoretical reflection on the domain of lesbian health, dominated by heteronormative and heterosexist concepts and practices both in research and in health care. By means of a critical contextualization of the literature, specific health needs of lesbians were identified and the interventions of health care professionals and services were questioned. Specific concrete actions are proposed in the fields of health promotion and in the eradication of discrimination and inequality in health care.

A população lésbica em estudos da saúde: contributos para uma reflexão crítica / The lesbian population in health studies: contributions for a critical reflection

Durante décadas, no pensamento e nas práticas das ciências da saúde e da psicologia a sexualidade lésbica foi associada à patologia. Ao longo do século XX, este posicionamento modificou-se. Este trabalho analisa essas mudanças numa reflexão teórica focada no domínio da saúde das lésbicas, no qual predominam as concepções e práticas heteronormativas e heterossexistas, tanto na investigação como na prestação de cuidados. Através de uma contextualização crítica da literatura, identificamos as necessidades específicas das lésbicas, questionamos as intervenções dos profissionais e serviços de saúde e propomos medidas de ação concretas de promoção da saúde e de erradicação da desigualdade e discriminação.

For decades, lesbian sexuality was associated with pathology in the attitudes to and practices of health sciences and psychology. During the twentieth century that position changed gradually. This article analyzes these changes in a theoretical reflection on the domain of lesbian health, dominated by heteronormative and heterosexist concepts and practices both in research and in health care. By means of a critical contextualization of the literature, specific health needs of lesbians were identified and the interventions of health care professionals and services were questioned. Specific concrete actions are proposed in the fields of health promotion and in the eradication of discrimination and inequality in health care.

Cardiac troponin I: prothrombotic risk marker in non-valvular atrial fibrillation.

BACKGROUND: Evidence of a link between small rises in cardiac troponin I (cTnI) and an increased risk of thromboembolic events (TE) in atrial fibrillation (AF) is currently scarce. OBJECTIVES: We aimed to assess the relation between cTnI and findings of an increased thromboembolic risk in patients with non-valvular AF using transesophageal echocardiography. METHODS: We have included 245 patients performing transthoracic and transesophageal echocardiogram, alongside with laboratory assessment (including cTnI) in a cross-sectional survey. Changes associated to TE were sought on transesophageal echocardiogram: left atrial or left atrial appendage thrombus, dense spontaneous echocardiographic contrast, low flow velocities in the left atrial appendage and protuberant aortic plaques. Comparisons were performed according to the baseline concentration of cTnI, regarding the prevalence of these changes. We have added cTnI to CHADS2 and CHA2DS2-VASc scores in order to assess its capability to refine risk stratification using transesophageal markers as surrogate endpoints and assessed it by means of ROC-curve analysis and Net Reclassification Improvement (NRI). RESULTS: A direct relation between rising concentrations of cTnI and a higher prevalence of transesophageal echocardiogram changes was found. Furthermore, the addition of cTnI to CHADS2 and CHA2DS2-VASc scores improved their ability to predict changes associated to TE on transesophageal echocardiography both through ROC-curve analysis and NRI. CONCLUSION: cTnI seems to be associated to thromboembolic risk in patients with AF. The possible role of cTnI in the refinement of risk stratification schemes needs to be tested in further prospective studies using clinical endpoints.

Aquarium sign in sepsis.

A 91-year-old man appeared in our lab with fever for a transthoracic echocardiography assessment. Highly unusual echo images were found, with a size and movement resembling 'bubbles in an aquarium' in every cardiac chamber, both left and right. The patient died 8 days later, due to a methicillin-resistant Staphylococcus aureus sepsis. These are highly unusual images that should not be confused with microbubbles from contrast agents or radiofrequency ablation, and were previously reported once in association with atrioesophageal fistula.